Abstract
Allogeneic hematopoietic stem cell transplantation (HCT) is a treatment that offers potential durable remission for many hematological malignancies, and chronic graft-vs-host disease (cGVHD) is a major, long-term complication. cGVHD patients often have significant symptoms attributed to immunologic dysfunction and require significant follow up and treatment. Psychiatric burden and utilization, however, is not as adequately described in this population.
• To describe psychiatric utilization in patients who subsequently developed cGVHD
• To analyze whether patients are being followed by psycho-oncology service
• To report the most common psychiatric diagnoses given and medications prescribed in this population
We conducted a retrospective chart review of 55 patients with cGVHD following allogeneic HCT treated at our center between 2010 and 2024. The analysis focused on clinical factors including psychiatric diagnoses, use of psychiatric medications, and the number of inpatient psychiatry consultations, both at baseline and post-HCT.
Eighteen (32.7%) patients had at least one psychiatric diagnosis before HCT with the most common being depression and anxiety. Of these patients, 12 (66.7%) were on at least one psychiatric medication with antidepressants being the most common drug class. After HCT, most patients (n= 42, 76.4%) had at least one psychiatric diagnosis with the most common being depression, anxiety, and insomnia. Of these patients, 36 (85.7%) were treated with at least one psychiatric medication: 30 (71.4%) received antidepressants, 21 (50%) received benzodiazepines, and 8 (19%) received antipsychotics. Psychiatric specialty care/follow up was documented in 15 (35.7%) patients. Specifically, 28/55 (50.1%) patients developed a new psychiatric diagnosis after their cGVHD diagnosis.
Patients who develop chronic graft-versus-host disease (cGVHD) after hematopoietic cell transplantation (HCT) experience a significant mental health burden. Only 13 (23.6%) of these patients had no history or subsequent need for psychiatric care. Among those with psychiatric diagnoses or medication use after HCT, just 35.7% received evaluation from the psycho-oncology service. This suggests a substantial number of patients could benefit from specialized mental health support but are not currently receiving it. We plan to expand our evaluation and compare these findings to HCT survivors who did not develop cGVHD.